South Africa 'slow' to combat killer TB strain*

Victoria Macdonald in Tugela Ferry, Sunday Telegraph
Last Updated: 11:56pm BST 21/04/2007

South Africa's government has been accused of dangerously delaying its
response to an outbreak of a "virtually untreatable" tuberculosis strain
that has killed more than 230 people.

Doctors warned the health minister, Dr Manto Tshabalala-Msimang, nearly
two years ago that they had discovered cases of extreme drug-resistant
TB (XDR-TB) - a lethal mutation of the disease - in the rural town of
Tugela Ferry, in KwaZulu-Natal province.

A TB sufferer, South Africa 'slow' to combat killer TB strain
Fight for life A TB sufferer at Tugela Ferry hospital

However, critics say the minister banned government officials from
attending emergency meetings, while the press was forbidden to report
from the hospitals involved.

Doctors at the Church of Scotland Hospital in Tugela Ferry identified
the outbreak after patients with Aids, who had previously been
responding well to retroviral drugs, suddenly began dying.

Tests established that they were facing an outbreak of the most
dangerous form of TB, regarded as virtually untreatable by the World
Health Organisation (WHO), which fears that it has the potential to kill
millions - with those who have contracted the HIV virus particularly
vulnerable.

Of the 241 patients known to have caught XDR-TB in KwaZulu-Natal, 221
have died. Across the rest of the country, 16 other deaths have been
recorded, and doctors fear that many more people may be infected. Four
health workers at the hospital in Tugela Ferry have contracted XDR.
About 6,000 South Africans are already infected with a different strain
- multi-drug-resistant (or MDR) TB - which can be treated but which
still kills about a third of sufferers.

Health officials are concerned that in many clinics, patients with
different strains are treated on the same wards, instead of being
isolated to prevent cross-infection and the risk of even deadlier mutant
strains developing.

In some places, TB patients have been put on general wards, while
children with MDR-TB have been allowed to attend school.

In a film to be screened by Channel 4 News this week, Dr Nesri
Padayatchi, a TB consultant with the South African Aids research
organisation, Caprisa, said the health minister had banned officials
from attending a crisis meeting on XDR-TB in Johannesburg last
September. It was organised by the WHO, the South African Medical
Research Council, and representatives from other African countries.

Dr Padayatchi said: "Dr Tshabalala-Msimang was not present and, on her
instruction, nobody else from the department of health was there either."

Journalists were also banned from visiting any of the clinics with
XDR-TB patients. "Part of the reason is they didn't want any further
damage to the image of the department of health," Dr Padayatchi added.

A spokesman for the department said the WHO had not informed its
officials of the conference - a claim disputed by the organisers.

South Africa's leaders have been repeatedly criticised for their
reluctance to acknowledge the scale of the nation's HIV-Aids crisis, or
to take measures to contain it. Until recently, President Thabo Mbeki
disputed the link between HIV and Aids, while Dr Tshabalala-Msimang drew
worldwide ridicule by claiming that eating garlic, beetroot and lemon
could combat the virus. One in six South Africans is infected with HIV.

International health workers fear that such official attitudes might now
hinder effective treatment in what they see as a burgeoning TB crisis.
They say that pleas to set up screening and medical procedures for the
most vulnerable patients are being ignored.

Dr Gilles van Cutsem, who runs a clinic for the charity Médecins Sans
Frontières near Cape Town, said there should have been routine
surveillance for XDR-TB. It had been discovered only when people began
to die. He said: "It is still not part of routine surveillance in most
of Africa. Here, they could have done it before but they did not."

Since the health minister went on sick leave at the end of last year,
her temporary replacement, Jeff Radebe, has ordered officials to draw up
a plan to deal with XDR-TB. The health department's director-general,
Thami Mseleku, said he did not accept that South Africa had been slow to
react.

"There have been, of course, challenges with regard to differing views
about strategy and these will always be there," he said. "Those who say
we have been slow - it is because they belong to a certain view about
strategy."

• The number of new TB cases in Britain has risen steadily for the past
25 years. Last year, there were 8,171 cases across England, Wales and
Northern Ireland, almost half of them in London, and up two per cent on
the previous year, according to government figures.

• About 250,000 people in Britain had TB at the start of the last
century, with mortality rates of 40,000 a year.